Individual
PATRICK L WYFFELS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5401 N KNOXVILLE AVE, SUITE # 302, PEORIA, IL 61614-5098
(309) 589-0600
(309) 589-0602
Mailing address
5401 N KNOXVILLE AVE, SUITE # 302, PEORIA, IL 61614-5098
(309) 589-0600
(309) 589-0602
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036063794
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036063794
—
IL
01
—
07200634
BLUECROSS BLUESHIELD
IL
Enumeration date
12/14/2006
Last updated
12/07/2007
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